Provider Demographics
NPI:1770316465
Name:SIMPLE GUIDANCE
Entity type:Organization
Organization Name:SIMPLE GUIDANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:OKENTU
Authorized Official - Last Name:FALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:609-481-8904
Mailing Address - Street 1:47 WOLF PL STE 1
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-1019
Mailing Address - Country:US
Mailing Address - Phone:609-481-8904
Mailing Address - Fax:
Practice Address - Street 1:14 BEAVERDALE LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1612
Practice Address - Country:US
Practice Address - Phone:609-481-8904
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health